Reflections on the digital journey across Frimley ICS

The digital agenda is constantly evolving. And in the NHS, many new integrated care systems (ICSs) are still working out their oversight and governance roles. As system leaders therefore, we must navigate these shifting contexts. This will require strong networks, partnerships and trust. These characteristics have underpinned our digital achievements in Frimley. It sounds obvious, but embedding collaboration across your system takes time and will yield results.

Across the NHS Frimley Health and Care Integrated Care System (Frimley ICS), our Connected Care programme and shared care record are being used broadly across the system with thousands of examples of daily use. Over winter we quickly deployed remote monitoring capability to support complex patients such as care homes residents and expanded this to support patients with long-term respiratory, heart failure and diabetes conditions. We have also made transformational steps in resident-facing services and primary care and are now looking to support digital literacy and championing to encourage further adoption of new digital ways of working.

Crucially and at the outset, there must be trust between organisations when sharing data

This process however has not been a 'big bang'. When we began, we weren't overly prescriptive with targets and milestones. Instead, we focussed on delivering benefits for our residents and patients incrementally with a gradual roll out rather than fostering an 'all or nothing' mindset which can hinder progress. This also meant we could learn quickly along the way. Starting small and iterating has helped us build momentum and deliver meaningful change.

Crucially and at the outset, there must be trust between organisations when sharing data. Our shared care record is a focal point for information from across our system. Our partner organisations need to trust that the data we collect is not a performance management tool – it's our role as ICS leaders to ensure that the trust is there. By keeping the focus on the health and care of our residents and making sure that we are transparent in our decision making, we can cultivate the sense of empowerment which is imperative for transformation.

In a system environment, the traditional leadership model in which single points of accountability exist within the construct of a statutory body is no longer fit for purpose

Equally, we have only been able to create this culture at Frimley ICS because our leaders and executives recognise that their evolving role is to ensure that partners remain around the table, are involved and understand how the work supports our broader strategic context and operating model.

In a system environment, the traditional leadership model in which single points of accountability exist within the construct of a statutory body is no longer fit for purpose. Instead, we all have a part to play in creating a sense of shared accountability around a common agenda, and it is this shift which forms the bedrock of our transformation work. As we continue to develop this way of working, we have been able to focus on our digital strategy and its potential to improve health outcomes and inequalities for our population in line with the four core purposes of ICSs.

When it comes to the digital work itself, there are three additional considerations to highlight which go beyond system architecture:

1. Analytics: In the first instance, analytics are key to our understanding of where in our population health inequalities exist, where we have significant variation in outcomes, access and overarching life expectancy. Mapping this across the system requires the development of analytical capabilities supported by digital tools which can generate accurate data. We are then able to take action to enhance care for our population.
2. Workforce: Digital is already playing an important role as we attempt to navigate staff vacancies and support our existing healthcare professionals whilst they continue to care for our population. Digital can create efficiencies which can ease administrative workload of overburdened clinical staff and would allow our staff to prioritise patient care, improving conditions for both our front-line workers, and the experience of those they care for.
3. Digital exclusion: It is essential that in attempting to solve current inequalities, we neither create additional issues nor exacerbate existing ones. In health and care, above all, we need to ensure that there is always a route to services for those at risk of digital poverty and exclusion.
   
   In Frimley we have developed tools such as digital exclusion checklists and explored the use of flags in the shared care record which would allow our staff to raise alerts when there is risk of exclusion. We have also been looking at alternative ways of accessing services for those who are digitally excluded so we can make sure that we are protecting those who are most vulnerable.

Our ambition is to be data driven, but we need to retain the compassion that is core to our health and care services. While there is no substitution for eyes on intelligence for truly understanding a patient and their needs, digital tools, programmes and initiatives, combined with a foundation of trust and a culture of collaboration, can enhance the quality of care for our populations, improve the experiences of our clinical workforce and confront the challenges we face more widely across the sector.   

Sam Burrows is the chief transformation and digital officer at NHS Frimley Health and Care Integrated Care System.

First published on NHS Providers' website as part of the Digital ICS programme.